Intimate Partner Violence and HIV Prevention Continuum Engagement Among Transgender and Nonbinary Populations

总结/摘要 跨性别和非二元（TGNB）的人经历亲密伴侣暴力（IPV）的惊人速度是 他们的顺性别同龄人。先前的工作已经将IPV与性风险行为和增加的HIV血清转化风险联系起来 在TGNB中，但对IPV对艾滋病毒和性传播感染（STI）检测的影响知之甚少， TGNB中暴露预防（PrEP）的吸收和持续性。虽然过去的研究结果表明IPV的潜力 对艾滋病毒预防连续参与产生强烈的有害影响，IPV的经验和对 艾滋病毒/性传播感染的风险和预防行为还有待于在不同的TGNB人群中进行研究。额外 目前需要进行研究，以模拟跨性别女性（TF）、跨性别女性和跨性别女性亚组的IPV和艾滋病毒风险之间的途径。 男性（TM）和性别非二元（GNB）的人。以Syndemic和 少数人压力理论，拟议的创新观察性队列研究将研究IPV的具体形式 (e.g.,身体、性、情感、控制性别表达和/或过渡）的背景下， 亲密关系有助于TGNB人群中的HIV/STI风险和保护行为， 一个24个月的期限具体而言，我们的目标是：1。使用定性方法，探索感知的关联 性别间IPV、关系特征和动态与HIV风险和预防行为的关系 不同的TGNB人。2.检查IPV与艾滋病毒检测纵向关联中基于性别的差异， PrEP摄取、PrEP持续性、STI诊断（主要结局）、无安全套性行为和HIV血清转换 （次要结果）在种族和民族多样化的TGNB人群（TF，TM和GNB组）中。3. 确定个人、人际、网络、社区和结构层面的风险和复原力因素， 调解（或缓和）IPV和艾滋病毒风险之间的关联和保护行为的每一组。4.使 根据定量分析，提出干预措施建议， 在技术专家的指导下，对来自同期组群的数据和定性数据进行分析。我们将评估性风险行为， 艾滋病毒和性传播感染检测，并评估在24个月的随访中PrEP的吸收和持续性。我们假设 IPV对HIV/STI风险的频率、严重程度和总体影响在以下人群中存在差异： TGNB人员。我们还怀疑IPV的发生频率更高与儿童虐待史、精神疾病史、 健康问题，物质使用，性风险和较低水平的艾滋病毒检测，PrEP吸收和PrEP持久性。 我们预计，参与者及其伴侣之间的酒精和物质使用将与以下因素高度相关： IPV发作和HIV危险行为。我们还假设，性别肯定，应对技巧， 社会支持将介导IPV对危险行为、HIV检测、PrEP摄取和PrEP持续性的影响。 拟议的研究将促进我们对与预防和应对气候变化相关的风险和弹性因素的理解， 减少IPV，减少IPV相关的危险行为，并增加不同TGNB中的HIV保护行为 人士这项研究将为IPV、艾滋病毒和药物滥用干预措施的制定和调整提供信息 对于TGNB的人来说。

SUMMARY/ABSTRACT Transgender and non-binary (TGNB) persons experience intimate partner violence (IPV) at alarming rates twice that of their cisgender peers. Prior work has linked IPV to sexual risk behavior and increased risk for HIV seroconversion among TGNB, but less is known about the impact of IPV on HIV and sexually transmitted infection (STI) testing, pre- exposure prophylaxis (PrEP) uptake, and persistence among TGNB. While past findings suggest the potential for IPV to have a strong deleterious effect on HIV prevention continuum engagement, IPV experiences and impacts on HIV/STI risk and prevention behaviors have yet to studied among a diverse group of TGNB persons. Additional research is currently needed to model pathways between IPV and HIV risk for subgroups of trans feminine (TF), trans masculine (TM), and gender non-binary (GNB) persons. Guided by a framework that combines Syndemic and Minority Stress Theory, the proposed innovative observational cohort study will examine how specific forms of IPV (e.g., physical, sexual, emotional, controlling gender expression and/or transition) in the context of steady or casual intimate relationships contribute to HIV/STI risk and protective behaviors among subgroups of TGNB persons over a 24-month timeframe. Specifically, we aim to: 1. Using qualitative methodologies, explore the perceived associations between IPV, relationship characteristics and dynamics, and HIV risk and prevention behaviors among gender diverse TGNB persons. 2. Examine gender-based differences in the longitudinal associations of IPV with HIV testing, PrEP uptake, PrEP persistence, STI diagnosis (primary outcomes), condomless sex, and HIV seroconversion (secondary outcomes) among a racially and ethnically diverse cohort of TGNB persons (TF, TM, and GNB groups). 3. Determine the individual-, interpersonal-, network-, community-, and structural-level risk and resilience factors that mediate (or moderate) the associations between IPV and HIV risk and protective behaviors for each group. 4. Make recommendations for interventions that interrupt the pathways between IPV and HIV/STI risk based on quantitative data from the cohort and qualitative data, guided by technical experts. We will assess sexual risk behavior, conduct HIV and STI testing, and assess PrEP uptake and persistence over the 24 months of follow-up. We hypothesize that there will be differences in the frequency, severity, and overall impact of IPV on HIV/STI risk among subgroups of TGNB persons. We also suspect greater frequency of IPV will be associated with history of childhood abuse, mental health problems, substance use, sexual risk taking and lower levels of HIV testing, PrEP uptake, and PrEP persistence. We anticipate that alcohol and substance use among participants and their partners will be highly associated with episodes of IPV and with HIV risk behavior. We also hypothesize that experiences of gender affirmation, coping skills and social support will mediate the effects of IPV on risk behavior, HIV testing, PrEP uptake, and PrEP persistence. The proposed study will advance our understanding of both the risk and resiliency factors relevant to preventing and reducing IPV, reducing IPV-associated risk behaviors, and increasing HIV protective behaviors among diverse TGNB persons. This research will inform the development and adaptation of IPV, HIV, and substance abuse interventions for TGNB persons.